Chapter 43: Drugs Affecting Blood Pressure, 47: Lipid-Lowering Agents, & 48: Drugs Affecting Blood Coagulation
An older adult client's most recent physical assessment and diagnostic workup reveal the presence of dyslipidemia. The client is a candidate for monotherapy with a statin, and she will soon begin treatment with atorvastatin. The nurse should anticipate what prescription from the health care provider?
"Atorvastatin 10 mg PO OD"
A client prescribed ramipril earlier in the week states, "Now I have a nagging, dry cough." How should the nurse best follow-up the client's statement?
"Drugs like ramipril often cause a cough in clients; we should speak to the health care provider."
After teaching a client about prescribed statin therapy, the nurse determines that additional teaching is needed when the client makes which statement?
"I can take the drug with grapefruit juice."
A client, prescribed amlodipine, asks how this drug works. What is the nurse's best response?
"It dilates peripheral arteries and relaxes vascular smooth muscle."
A 58-year-old man has recently been prescribed atorvastatin (Lipitor) in an effort to reduce his cholesterol levels. The man has acknowledged the potentially harmful effects of hyperlipidemia and is motivated to make changes to resolve this health problem. What advice should the nurse give to this client?
"It's a good idea to keep your intake of saturated fat to a bare minimum."
A 39-year-old nulliparous woman has been taking atorvastatin for 2 years and has now decided that she would like to become pregnant. What health education should the nurse provide to this client?
"It's important that you stop taking atorvastatin before you stop using contraception."
A client is receiving low-molecular-weight heparin (LMWH) to prevent thromboembolic complications. The nursing student asks the instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin?
"LMWH is associated with less thrombocytopenia than standard heparin."
A client with primary hypertension asks the nurse why the prescriber added another medication to assist with lowering the blood pressure. What is the nurse's best response?
"Many clients require two or more drugs for high blood pressure."
An 86-year-old male client who was admitted earlier in the week with thrombophlebitis is being sent home on enoxaparin. Which statement by the client suggests that he understands proper management of his condition and proper use of the drug?
"The medication will increase my risk of bleeding."
What should the nurse teach an older adult client about the potential adverse effects of atorvastatin?
"The most common side effects of atorvastatin involve some mild gastrointestinal upset."
A female client is taking a large dose of nicotinic acid to treat hyperlipidemia. She calls the clinic and reports that her face, neck, and chest are red. Which would be an appropriate response by the nurse?
"This is an expected adverse effect of the drug. It should subside in time."
The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse's best response?
"With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease."
A patient is receiving atorvastatin. The nurse would anticipate that the maximum effectiveness of the drug would occur within which time frame?
1 to 2 hours
The nurse is measuring the blood pressure of a client during a follow-up office visit. What blood pressure reading, if it repeats a measurement taken during a previous visit, would indicate hypertension?
115/85 mm Hg
A nurse is providing care to a client diagnosed with stage 2 hypertension. The nurse understands that most clients with stage 2 hypertension will require how many antihypertensives to lower blood pressure to goal initially?
2
The nurse is reviewing the coagulation studies of a client who is receiving a heparin infusion. The client's baseline partial thromboplastin time is 32 seconds. Which result would indicate therapeutic effectiveness?
64 sec
A client receiving heparin has a baseline aPTT of 28 seconds. Which result would the nurse interpret as suggesting too much heparin?
98 seconds
A nurse will use extreme caution when administering heparin to which patient?
A 38-year-old male with peptic ulcer disease
A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regimen to better control the client's hypertension?
A diuretic
The client has been prescribed lovastatin to treat mixed lipidemia. In addition to monitoring cholesterol levels, what other laboratory test value needs to be monitored on a routine basis during therapy?
AST & ALT
A client is receiving nitroprusside. The nurse suspects that the client is experiencing cyanide toxicity based on assessment of:
Absent reflexes
A nurse is educating a group of nursing students on the mechanisms of action of angiotensin-converting enzyme inhibitors (ACEI). Which medication should the nurse explain as the hormone produced by the adrenal cortex?
Aldosterone
Which activity increases high-density lipoproteins?
All of these
A nurse is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics. Treatment of high cholesterol using statins would be contraindicated in which client?
An obese male client who is a heavy alcohol user and who has cirrhosis of the liver
A 42-year-old client is seen by the health care provider for follow-up for diabetic nephropathy. The provider prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to?
Angiotensin II receptor blockers
The health care provider orders thrombolytic agents when treating a client diagnosed with acute myocardial infarction. When specifically considering this client, which drug should the nurse keep readily available when blood flow is reestablished?
Antiarrhythmics
A client with metabolic syndrome is encouraged to implement nonpharmacologic measures improve his risk factors. What do those non-pharmacologic measures include? (Select all that apply.)
Begin a low-fat diet Walk regularly
A client taking warfarin after open heart surgery reports pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of the medications and the report of pain, what should the nurse suspect is the cause of the pain?
Bleeding
A patient with atrial fibrillation is receiving warfarin therapy. The patient is also prescribed ezetimibe. The nurse would instruct the patient to watch for:
Blood in urine or stool
A nurse is caring for a patient who is receiving lovastatin. Which assessment by the nurse would indicate that there is possible damage to the patient's skeletal muscle as a result of the drug therapy?
Brownish colored urine
A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which mode of action helps losartan to bring about its antihypertensive effect?
By blocking the angiotensin II receptors
A 60-year-old client experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The client has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect?
By inactivating clotting factors and thus stopping the coagulation cascade
When educating a group of nursing students on the mechanism of action of angiotensin converting enzyme inhibitor (ACEI) drugs, the nurse identifies what as the action brought about by aldosterone?
Causes sodium and water retention.
Blood lipids are a category of fatty acids, which are substances used within the body to perform essential functions. Which category of blood lipids is involved in the formation of atherosclerotic plaques?
Cholesterol
Which would be classified as a bile acid sequestrant?
Cholestyramine
Which would a nurse identify as a carrier for small units of fats?
Chylomicrons
A nurse is preparing to administer an antiplatelet drug. Which medication would the nurse most likely administer?
Clopidogrel
An older adult client with a history of mild renal failure has experienced two different transient ischemic attacks (TIAs) and has been prescribed clopidogrel therapy. What statement should be the basis of the nurse's response when asked why aspirin (ASA) wasn't prescribed as the drug of choice?
Clopidogrel is believed to be more effective than aspirin in treating TIAs.
A nurse is caring for a client receiving cholestyramine to improve his blood lipid profile at a home care setting. What adverse reactions to cholestyramine should the nurse monitor in the client?
Constipation
A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance?
Cough
A nurse is caring for a client experiencing a hypertensive emergency. If blood pressure is not lowered immediately, what can occur? (Select all that apply.)
Damage to the heart Damage to the kidneys Damage to the eyes
A client asks the nurse what the atorvastatin (Lipitor) prescribed for the client will do. What is an expected outcome for this client?
Decrease in serum cholesterol and LDL level
A nurse is preparing to administer a prescribed bile acid resin to a client with hyperlipidemia. The nurse understands that this class of drugs can decrease serum levels of several medications, primarily via which mechanism?
Decreased gastrointestinal absorption
When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in the periphery of the body. An ICU nurse caring for a patient in circulatory shock knows that the pooling of blood in the periphery leads to:
Decreased venous return
Which of the following best reflects the action of ezetimibe?
Decreases the absorption of dietary cholesterol from the small intestine
A client with which diagnosis should be prescribed captopril as the first-line treatment?
Diabetes mellitus
A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management?
Diastolic blood pressure below 90 mm Hg
Key behavioral determinants of blood pressure are related to what factor?
Dietary consumption of calories and salt
A client is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication?
Digoxin
A 35-year-old female client controls the symptoms of her cardiovascular disease with ACE inhibitors. She discovers that she is pregnant and contacts her primary care provider regarding her medication regimen. What would the nurse expect the provider to do?
Discontinue the drug
A nurse is caring for a patient who is on a drug regimen of midodrine to treat their hypertension. What would be an appropriate nursing diagnosis to include in the care plan of this patient?
Disturbed sensory perception (visual, kinesthetic, tactile) related to CNS effects
The client is prescribed warfarin. His INR is 5.2. At what level is this dose?
Elevated
As part of a routine physical examination, a 60-year-old client's primary care provider has ordered blood work that includes cholesterol levels. What result would strongly suggest the need for an antihyperlipidemic drug?
Elevated LDL levels
There are two pathways that can be activated by the coagulation process. One pathway begins when factor XII is activated. The other pathway begins when there is trauma to a blood vessel. What are these pathways?
Extrinsic and intrinsic pathways
A 55-year-old man's hypertension has not responded adequately to his current medication regimen consisting of an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which nursing action?
Frequent assessment of the client's cardiac status
A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?
Frequently monitor blood cholesterol.
A client asks the nurse about herbal products that can help to lower serum cholesterol and triglycerides. Which herbal product would the nurse include in the response?
Garlic
The three major classes of drugs used to control blood lipids are statins, bile acid resins (or sequestrants), and fibrates. Which is a fibrate?
Gemfibrozil
The client is currently receiving a continuous IV infusion of heparin. Which procedure should the nurse avoid when possible?
Giving intramuscular injections
The nurse instructs a client to take the prescribed pravastatin at bedtime based on understanding that:
Greater drug effectiveness is achieved at this time.
The nurse is evaluating the effectiveness of drug therapy in a client with hyperlipidemia. Effective therapy is best demonstrated by which laboratory values?
HDL 58 LDL 96 Cholesterol 178
The pharmacology instructor is discussing medications used in the treatment of dyslipidemia. Which drug class would the instructor identify as the most widely used dyslipidemia drugs?
HMG-CoA reductase inhibitors
Which drug is most effective in reducing most major types of dyslipidemia in patients at risk or who have already developed CAD?
HMG-CoA reductase inhibitors
After teaching a group of students about drugs used to treat hyperlipidemia, the instructor determines that the teaching was successful when the students identify which of the following? Select all that apply.
HMG-CoA reductase inhibitors Fibric acid derivatives Bile acid resins
The client is diagnosed with primary hypertension. The nurse is educating a client about dietary changes that help decrease blood pressure. Which menu selection indicates the need for further client education?
Ham sandwich with mustard, carrots and cheesy dip
A nurse is providing care to a client who has elevated levels of low-density lipoprotein (LDL). A review of the client's history reveals a sedentary lifestyle and a history of being overweight. The nurse understands that this combination of factors places the client at risk for which condition?
Heart disease
A client with a history of clot formation is scheduled for bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically?
Heparin
A female client is started on warfarin therapy. The client asks the nurse why she is no longer on heparin therapy. What differentiates heparin from warfarin?
Heparin is administered parenterally, while warfarin is administered orally.
What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism?
His dietary intake of saturated fat
Mr. Hon has been admitted to the hospital and placed on anticoagulant therapy. For what blood-related disorder is this therapy used?
Hypercoagulation
The nurse is providing education to a client with diabetes mellitus who has been prescribed captopril. What potential adverse effect will the nurse include in the teaching?
Hyperkalemia
The nurse is caring for a patient at risk of shock. What physiologic response would the nurse know to look for while assessing for shock?
Hypoperfusion of tissues
A patient, aged 78 years, is receiving nitroprusside for hypertensive emergency. For which condition should the patient be assessed?
Hypotensive crisis
A 48-year-old client with a blood pressure of 198/112 mm Hg reports severe headache and drowsiness. The nurse notes that the client is disoriented and has begun to vomit. What is the primary nursing goal for this client experiencing a hypertensive emergency?
Implement interventions to lower blood pressure.
A nurse is caring for a client receiving warfarin drug therapy. The client informs the nurse that he is also taking chamomile, which is an herbal remedy. The nurse would alert the client to which adverse effects?
Increased risk for bleeding
When preparing a plan of care for a client in hypovolemic shock, which partial nursing diagnosis might be relevant to the patient's condition?
Ineffective Tissue Perfusion
A client has not responded normally to rescue inhaler therapy. When subcutaneous epinephrine is prescribed, the nurse should anticipate what reaction to occur?
Instant bronchodilation
A client asks how ezetimibe will help to treat high lipid levels. The nurse explains that:
It decreases the absorption of cholesterol in the small intestine.
The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside?
It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins.
Which lipid level would the nurse interpret as being high?
LDL 190 mg/dl
A client appears to be a candidate for statin therapy. What laboratory value should be assessed prior to initiating therapy?
LFTs
The health care provider prescribes fibrate for a client with elevated triglycerides. The client begins to self-administer niacin approximately 3 mg daily. What would the nurse expect the provider to order?
LFTs
After teaching a group of students about the cardiovascular system and pressures, the students demonstrate understanding of the information when they identify which area as having the highest pressure?
Left ventricle
A client develops primary hypertension and asks the nurse, "How long will I need to receive therapy?" The nurse responds based on the understanding that therapy would be required for how long?
Lifelong
A nurse is preparing to administer an antihypertensive drug that lowers the blood pressure primarily via suppression of the renin-angiotensin-aldosterone system. Which drug might this be?
Lisinopril
An elderly client with dyslipidemia has had fenofibrate added to the existing medication regimen. In addition to having the lipid profile drawn on a regular basis, the nurse should educate the client about the need for what ongoing laboratory testing during therapy?
Liver panel
A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify what as an example of an angiotensin II receptor blocker?
Losartan
Captopril therapy has a potentially adverse effect of neutropenia. When taking captopril, which patient would be at the greatest risk for developing this side effect?
Mark, who is suffering from impaired renal function
A client is experiencing orthostatic hypotension that is affecting his ability to function. Which medication would be most appropriate?
Midodrine
The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient?
Monitoring for complications and side effects of treatment
How can the home care nurse assist the client or the client's family members who have hypertension? (Select all that apply.)
Monitoring for drug effects Promoting compliance with the prescribed pharmacologic modifications Promoting compliance with the prescribed lifestyle modifications
A nurse at a long-term care facility is conducting a medication reconciliation for a client who has just moved into the facility. The client is currently taking clopidogrel. The nurse is most justified suspecting that this client has a history of what condition?
Myocardial infarction
After receiving the results of an echocardiogram, a client has many questions regarding the results and their impact on the client's lifestyle. The client is a 57-year-old Hispanic man with a 10-year history of hypertension. The client would like to know what effect hypertension has on the heart. What is the nurse's best reply?
Myocardium hypertrophy
A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin?
NSAIDs
A client is taking lovastatin. Which are noted as the most common adverse effects?
Nausea, flatulence, and constipation
A female client presents to the health care provider's office with recurrence of her "hot flashes." The nurse understands that the client is taking what drug to treat her dyslipidemia?
Niacin
The nurse recognizes that which medication may be used to treat a hypertensive crisis?
Nitroprusside
A client is receiving warfarin. The nurse would expect to administer this drug by which route?
Oral
A client is taking warfarin to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin monitored?
PT and INR
A client, newly diagnosed with hypertension is started on captopril, an ACE inhibitor. The client should be informed of the possibility of what adverse effect?
Persistent cough
After reviewing the drugs that may interfere with warfarin, the students indicate that they need additional study when they identify what as requiring a dosage increase in the warfarin?
Phenytoin
A client is prescribed aliskiren. The nurse would monitor the laboratory test results of which electrolyte closely?
Potassium
HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category?
Pregnancy Category X
The nurse is caring for a postoperative client receiving dalteparin prophylactically to prevent deep vein thrombosis. The nurse should perform which ongoing assessment(s) for safe administration of the drug? Select all that apply.
Presence of dark tarry stools, or melena Presence of pain, edema, redness in leg Nasogastric drainage for presence of blood
The health care provider discovers a clot in the client's left lower leg. Anticoagulant drugs are prescribed to prevent formation of new clots and to achieve which other effect?
Prevent extension of clots already present
The pharmacology instructor is discussing heparin with the students. How would the instructor explain the action of heparin?
Promotes the inactivation of clotting factors
A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering:
Protamine sulfate
A nurse is caring for a 64-year-old female client who is receiving IV heparin and reports bleeding from her gums. The nurse checks the client's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which drug may be ordered?
Protamine sulfate
A patient is brought to the emergency department in hypertensive crisis. Nitroprusside is administered intravenously. The patient experiences diaphoresis and dizziness. Which is the appropriate action by the nurse?
Slow the rate of the infusion
When describing the action of calcium channel blockers, which would be an expected effect?
Slowed impulse formation
A client with a blood pressure of 165/95 mm Hg would be classified in which stage of hypertension?
Stage 2
The nurse is administering norepinephrine intravenous (IV) to an adult client diagnosed with septic shock. The client suddenly develops redness and edema at the right forearm IV site. The client's systolic blood pressure (SBP) is 88 mm Hg. Which action would the nurse implement first?
Stop the infusion and administer diluted phentolamine.
A client is to receive enoxaparin. The nurse would administer this drug by which route?
Subcutaneous injection
A client with a long history of hypertension has just been prescribed an alpha1-adrenergic receptor blocker. To reduce this client's risk of orthostatic hypotension and falls, the nurse should encourage the client to implement what intervention?
Take the medication at bedtime.
A client is being sent home with subcutaneous heparin after a total hip replacement. The nurse understands what symptom would indicate a serious drug reaction?
Tarry Stools
Which diuretic can be combined with an ACE inhibitor to increase its effectiveness in decreasing blood pressure?
Thiazide diuretics
Which would the nurse identify as the end of the intrinsic pathway?
Thrombin formation
What information would be included in a lipoprotein profile? Select all that apply:
Total cholesterol Triglycerides LDL
The nurse is reviewing the results of a client's lipid profile. Which of the following would the nurse identify as borderline high?
Triglycerides 180 mg/dL
A patient with metabolic syndrome usually has increased plasminogen activator levels.
True
The nurse is caring for a 42-year-old peri-menopausal client recently diagnosed with hypertension and prescribed benazepril. The client also takes over-the-counter ibuprofen for headaches. The nurse would provide which important points when educating the client on taking the new medication? Select all that apply.
Use barrier contraceptives while taking benazepril to prevent pregnancy, as it may cause severe birth defects. If swelling of the face, throat, or extremities occurs, hold the next dose and call the primary care provider immediately. A dry cough may develop when taking benazepril and it is not harmful, but if it is bothersome tell the primary care provider.
After reviewing the various antihypertensive agents, a group of students demonstrate the need for additional teaching when they identify which agent as a calcium channel blocker?
Valsartan
During ongoing assessment of a client receiving an antihyperlipidemic drug, what should the nurse collect? (Select all that apply.)
Vital signs Assessment of bowel function
A 73-year-old client receiving warfarin (Coumadin) has blood in the urinary drainage bag this morning. After reporting these observations to the health care provider, the nurse will expect to administer what substance?
Vitamin K
A client who has been treated with warfarin after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors?
Vitamin K
A client who is receiving warfarin has blood in the urinary drainage bag. What medication will likely be prescribed by the health care provider?
Vitamin K
The clinic nurse is caring for a 39-year-old black, male client who is 25 pounds overweight and has been newly diagnosed with hypertension after three consecutive blood pressure readings above normal. What will be initial drug therapy for this patient?
a diuretic
26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that:
a persistent, dry cough may occur; however, it is not serious.
A 26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that:
a persistent, dry cough may occur; however, it is not serious.
To compensate for clopidogrel's slow onset of action, the nurse should anticipate implementing which intervention?
administering a one-time loading dose that is higher than the maintenance dose
How does captopril contribute to a reduction of a client's blood pressure?
blocking the conversion of angiotensin I to angiotensin II
A nurse would caution a client receiving cholestyramine to avoid mixing the drug with:
carbonated beverages.
Which category of blood lipids is involved in the formation of atherosclerotic plaques?
cholesterol
A client is taking cholestyramine. The nurse will assess for which common adverse effect of the drug?
constipation
A client has had cholestyramine added to his or her treatment plan for dyslipidemia. What effect will cholestyramine have on the pharmacokinetics of the thiazide diuretic that the client is currently prescribed?
decreased absorption
Recommended treatments for clients with dyslipidemia are made according to their blood levels of total and low-density lipoproteins (LDL) cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations?
decreases target serum LDL level
In addition to being synthesized in the liver and intestine, from where are blood lipids derived?
diet
What antihypertensive agent is the most likely initial drug of choice for a black client?
diuretic
A client has been prescribed ramipril 5 mg PO daily with the scheduled dose due at 08:00. The nurse first reviews the client's most recent blood work and should consider withholding the dose because of what laboratory finding?
elevated potassium levels
An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident's medication regimen make create a risk for:
falls
A nurse is caring for a client who has been prescribed lovastatin to control blood lipid levels. While teaching the client about the medication, the nurse should caution against consuming large amounts of which?
grapefruit juice.
The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin?
headache and flatulence.
A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital?
heparin
The nurse is preparing to administer protamine emergently to a client per instructions from the health care provider. The nurse concludes this is necessary due to an adverse reaction to which drug?
heparin
A 54-year-old client has a cholesterol level of 240 mg/dL (6.2064 mmol/L). What serum concentration of cholesterol would this client have?
high
A nurse is caring for a male patient who has a diagnosis of coronary artery disease (CAD). His drug therapy includes lovastatin. Because the patient has a history of severe renal disease, the nurse will assess for a(n):
increase in plasma concentration of lovastatin.
A client's serum cholesterol is 286 mg/dL. Lovastatin (Mevacor) is prescribed. The nurse plans care based on the fact that the action of lovastatin:
inhibits the production of cholesterol.
A client who is malnourished and hypertensive client is being treated with losartan. Considering the client's nutritional status, how should the dose of the medication be adjusted in this client?
lowered
A clinic nurse has been assigned a 49-year-old female client who has a history of diabetes. A recent diagnosis of hypertension has been made, and the client has been prescribed a thiazide diuretic and labetalol. The client will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the nurse will be to:
monitor the client's blood pressure.
A client will begin taking atorvastatin, and the nurse is conducting relevant health education. The nurse should emphasize the need to report any new onset of:
muscle pain
A client is to receive clopidogrel. The nurse would expect to administer this agent by which route?
oral
A client is prescribed captopril. What adverse effect should the client be instructed on that can occur with angiotensin-converting enzyme (ACE) inhibitors?
persistent cough
An adult client presents with a blood pressure of 128/86 mm Hg. The client exercises regularly, is weight-appropriate for height, and indicates no use of tobacco or alcohol. How would the client's blood pressure be classified?
prehypertension
A client, diagnosed with left-sided heart failure, should be taught to recognize the signs and symptoms of the onset of what classic manifestation of this condition?
pulmonary edema
How does the nurse providing medication education describe how the drug atorvastatin achieves its desired therapeutic effect?
reducing the amount of cholesterol synthesized by the liver
An older adult client has been admitted to the emergency department with severe chest pain. Onset of symptoms is within the last 60 minutes. What medication would the nurse expect the health care provider to prescribe for this acute disorder?
thrombolytic drugs
How should the nurse instruct the client to take his lovastatin?
with food
A 50-year-old male patient has been admitted to the emergency department in cardiogenic shock. His wife, after hearing the nurse mention that the patient is receiving dobutamine, wants to know how the medication will help him. How would the nurse best answer her question?
"He's in shock because his heart can't pump effectively. This drug will help by causing his heart to pump more strongly."
While preparing a client for discharge, the nurse teaches about the proper use of warfarin, which has been prescribed by the physician. Which statement by the client indicates that additional teaching is required?
"I should use aspirin to control my arthritis pain."
Heparin therapy is prescribed to a client with deep vein thrombosis. Which client would be at greatest risk of bleeding from this therapy?
A 45-year-old corporate executive with peptic ulcer disease
A 59-year-old client with vascular disorders is prescribed cilostazol. The nurse instructs the client that it is for the treatment of what condition
Intermittent claudication
A nurse is caring for a client who has been diagnosed with primary hypertension. What nursing interventions should be included in the teaching plan? Select all that apply.
Regular aerobic exercise Diet with more fruits and vegetables Decreased alcohol consumption Smoking cessation
A student asks the instructor what the goal of drug therapy is in hypotension and shock. What would the instructor respond?
Restore and maintain adequate tissue perfusion.
A client is experiencing orthostatic hypotension that is due to antihypertensive therapy. Which nursing diagnosis would be most appropriate?
Risk for injury
A nurse is caring for a client who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed. Which should the nurse assess before beginning drug therapy?
Serum potassium levels
A stable daily dose of warfarin is reached when which parameter is achieved?
The PT and INR are within their therapeutic ranges, and the dose does not cause bleeding.
A client who is receiving cholestyramine also takes digoxin. The nurse teaches the client about the drug and administration. The client demonstrates understanding of the teaching when stating:
"I will take the digoxin about an hour before the cholestyramine."
The client receives a prescription for niacin. The nurse is providing education about the medication and possible adverse effects. Which adverse affect would the nurse include?
"Some people get very flushed skin when they take this medication."
A client who is receiving colestipol is also taking a thiazide diuretic. Which instruction would be most appropriate for the nurse to give?
"Take the thiazide diuretic about 1 hour before the colestipol."
A client calls the clinic and talks to the nurse. The client tells the nurse the client has been taking colesevelam (Welchol) for six months and that the client is having small amounts of bright red rectal bleeding and is concerned. What would an appropriate response from the nurse be?
"The bleeding may be coming from hemorrhoids. We should check this out."
Which client statement demonstrates an accurate understanding of the action of a prescribed anticoagulant?
"This medication will keep unnecessary clots from forming in my blood."
Which question would be most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension?
"When was your last menstrual period?"
A client taking a calcium channel blocker (nifedipine) also takes ranitidine for dyspepsia. The nurse assesses the client for which medication interactions?
Bradycardia
The nurse is caring for a client newly prescribed rosuvastatin. The nurse should perform which preadministration or ongoing assessments? Select all that apply.
Check the aspartate aminotransferase (AST), and if it is three times the normal, notify the primary care provider. Inspect the skin and eyelids for flat or elevated yellow deposits (xanthomas) and chart, if present. Evaluate for development of fever, muscle weakness or tenderness, or extreme fatigue and report to primary care provider. Determine if dizziness and unsteadiness of gait occurs after administering first dose of rosuvastatin.
A client develops a severe elevation in blood pressure. The physician orders an ACE inhibitor to be given intravenously. Which agent would be most likely?
Enalaprilat
Which agent would the nurse anticipate administering intravenously to lower a patient's severely elevated blood pressure?
Enalaprilat
An older adult client who resides in a care facility has been prescribed antihypertensives for the first time following many years of generally good health. When administering the first dose of the prescribed antihypertensive medication to an older adult, the nurse should recognize the related risk to which possible side effect?
Falls
The nurse is caring for a patient who is on thrombolytic therapy. The patient has a co-morbidity of renal insufficiency. What does the nurse know about the amount of heparin required to treat this patient?
Lower doses are required.
A client is taking cholestyramine (Questran) and ezetimibe (Zetia). What administration guideline is most important for the nurse to teach this client?
The administration of ezetimibe (Zetia) is four hours after cholestyramine.
A 37-year-old woman with moderately elevated lipid levels requests immediate pharmacotherapy for her dyslipidemia. The nurse explains that a period of intensive diet therapy and lifestyle modification will be utilized before drug therapy is considered. The nurse explains the rationale for this regimen as:
Therapeutic lifestyle changes are the preferred method for lowering blood lipids.
The nurse is caring for a 73-year-old client receiving warfarin. When the nurse performs the initial shift assessment, the nurse observes blood in the client's urinary drainage bag. After reporting the observation to the physician, which substance will the nurse likely administer?
Vitamin K
The provider orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client:
does not have peptic ulcer disease.
The nurse is caring for a 76-year-old client who is receiving IV heparin 5000 units q4h. At the initiation of therapy, the client's control activated thromboplastin time (aPTT) was found to be 35 seconds. One hour prior to the next scheduled dose, aPTT is determined to be 92 seconds. Based on this result, the nurse will:
hold the dose and contact the provider.